Provider Demographics
NPI:1942951314
Name:DERRICK SELB MFT
Entity Type:Organization
Organization Name:DERRICK SELB MFT
Other - Org Name:HUMAN POTENTIAL PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELB
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-538-2559
Mailing Address - Street 1:5266 HOLLISTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2066
Mailing Address - Country:US
Mailing Address - Phone:805-538-2559
Mailing Address - Fax:
Practice Address - Street 1:3710 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6180
Practice Address - Country:US
Practice Address - Phone:805-538-2559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health